{
"Npi": {
"NPI": "1871641878",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALLEGAN PHARMACY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "551 LINN ST",
"SecondLineMailingAddress": "STE120",
"MailingAddressCityName": "ALLEGAN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "269-673-4700",
"MailingAddressFaxNumber": "269-673-4711",
"FirstLinePracticeLocationAddress": "551 LINN ST",
"SecondLinePracticeLocationAddress": "STE120",
"PracticeLocationAddressCityName": "ALLEGAN",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49010",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-673-4700",
"PracticeLocationAddressFaxNumber": "269-673-4711",
"EnumerationDate": "01/08/2007",
"LastUpdateDate": "10/22/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEYDOUN",
"AuthorizedOfficialFirstName": "MOHAMED",
"AuthorizedOfficialMiddleName": "ALI",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "313-378-1938",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "5301008560",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}